Laura Wuellner

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http://wiki.cancer.org.au/australia/PDFs

Table 3. International Surveillance Guidelines
10Y/Routine screening
5Y
3y
1Y
Australian
2011
 
1-2 small (<10mm) tubular adenomas, LGD
3-4 adenomas;
≥10mm;
HGD, villous
≥5 adenomas
 
 
 
 
AGA
2012
(30)
No polyps or small (<10mm) hyperplastic polyps in the rectum or sigmoid
3-10 tubular adenomas;
≥10mm;
Villous or HGD
>10 adenomas (<3y)
1-2 small (<10mm) tubular adenomas
“The evidence supports a surveillance interval of longer than 5 years for most patients” P849
SSP < 10mm, no dysplasia
SSP≥10mm OR with dysplasia OR
Serrated adenoma
Serrated polyposis syndrome
Subsequent surveillance based on adenomas found
Canada
2013
(82)
1-2 small (<10mm) tubular adenomas with LGD
“Clinicians may want to individualise the surveillance interval based on adenoma size, family history and patient preference. There are data suggesting that 10years may be appropriate for most individuals” P226
3-10 tubular adenomas
≥10mm
Villous, HGD
>10 adenomas
SSA <10mm, no dysplasia
SSP≥10mm OR
with dysplasia OR
traditional serrated adenoma
Serrated polyposis syndrome
Subsequent surveillance based on adenomas found
ESGE
2013
(26)
1-2 small (<10mm) tubular adenomas with LGD
“Surveillance is not indicated in the low risk group” P848
≥10mm
HGD
Villous
≥3 adenomas
Serrated < 10mm, no dysplasia
Serrated ≥10mm or dysplasia
Routine screening
Repeat 3Y or 5Y for SC2 if no high risk adenomas found


 
10Y/Routine screening
5Y
3y
1Y
BSG 2010
NICE 2011
(BCSP)
(78)
1-2 small (<10mm) adenomas*


*Consider at 5y IF age, comorbidity, family history, accuracy and completeness of examination relevant
3-4 small (<10mm) adenomas;
≥10mm
≥5 small adenomas
≥3 adenomas at least one ≥10mm
No surveillance
Stop after one negative
Stop after two negative
Annual then as per ‘intermediate risk’
European
2010
(83)
1-2 tubular adenomas <10mm, LGD
3-4 adenomas
Any 10-19mm
HGD, villous
≥5 adenoma
≥20mm
within 1y
Routine screening
5y after one negative,
nil after 2 negative
3y if no high risk, 5y after 2 negative, else <1y
NZ
2012


1-2 tubular adenomas <10mm, LGD
Consider at 5y
1-2 adenomas ≥10mm
3-4 adenomas <10mm
HGD, villous
≥5 adenomas
3-4 adenomas if ≥10mm
Korean
(Lee 2017)
2012
1-2 small (<10mm) tubular adenomas, LGD
Villous, HGD,
≥10mm
≥3 adenomas
Serrated ≥10mm
Dutch
2013
(47)
PRS: 0
PRS: 1-2
PRS: 3-5
One point each for: 2-4 adenomas, size ≥10mm, villous histology, proximal location; Two points if ≥5 adenomas
Norway
1996


1-2 small tubular adenomas with LGD
HPP
Age >75 years
No remaining adenomas/remnants or unknown histology
No routine surveillance
≥3 adenomas
1-4mm adenomas left in situ
High grade dysplasia
Villous
≥10mm
10 years
Japanese
2014
Follow-up colonoscopy should be repeated within 3 years after polypectomy
Chinese
No recommended surveillance guidelines
*HGD high grade dysplasia LGD Low grade dysplasia SSP Sessile serrated polyps TSA Traditional serrated adenoma HPP Hyperplastic polyps







Table 2. Colorectal cancer incidence and mortality after adenoma removal
Author
Study
Years
Population
Follow-up

Outcomes

Brenner
2012
(7)
German
Case-control
III-2
2003-2010


2582 cases
1798 controls
Up to 10 years

Adjusted OR for CRC incidence at follow-up after polypectomy:

< 3 years: 0.2 (0.2-0.3), 3-5 years: 0.4 (0.3-0.6).,

6-10 years 0.9 (0.5-1.5) for both low and high risk adenomas.

Cottet
2012
(8)
French
Retrospective
cohort and registry


III-2
Incident adenomas:
1990-1999


Follow up:
31/12/2003
n=5779
Median follow up
7.7 years
IQR 5.2-10.5
Non-advanced adenomas:

n=3236


SIR 0.68 (0.44-0.99) regardless of follow-up;

SIR 0.60 (0.30-1.07) with a single follow up colonoscopy


10y cumulative probability of CRC was 0.76% (0.39-1.48) with and 1.37% (0.70-2.65) without surveillance colonoscopy.


Advanced adenomas:

n=1899


SIR 2.23 (1.67-2.92):

1.10 (0.62-1.82) with follow up

4.26 (2.89-6.04) without;


10y cumulative probability

2.05% (1.14-3.64) with

6.22% (4.26-9.02) without surveillance colonoscopy

Atkin
2017
(52)
UK
Retrospective cohort study
III-2
Incident adenomas 1990-2010


Follow up through 2014
n=11944
Median follow up
7.9 years
IQR 5.6-11.1.
3-4 small adenomas or 1-2 adenomas, at least one of which is ≥10mm
 
After adjustment for baseline risk factors, CRC incidence in the whole cohort was not significantly different from that of the general population (SIR 1·09, 95% CI 0·91–1·30); compared with no surveillance, one surveillance visit at median 2.9years (IQR 1.3-3.4), was associated with a significant reduction in colorectal cancer incidence rate (HR 0·57, 95% CI 0·40–0·80).
Loberg
2014
(6)
Norway
Registry
III-2
1993-2007
Mortality 2011
40826
Median follow up
7.7 years
(maximum 19)

Low risk group (no surveillance colonoscopy)

SMR 0.75 (0.63-0.88)

High risk group (surveillance colonoscopy every 10 years)

SMR 1.16 (1.02-1.31)

Removal of the first adenoma

1993-1999: SMR 1.17 (1.03-1.33) v 2000-2007: 0.76 (0.65-0.89)

Zauber
2012
(5)
USA
Cohort
(NPS)
III-2
1980-1990
2602
Median follow-up
15.8 years

SMR 0.47 (0.26-0.80)

Cumulative mortality at 20 y 0.8 v 1.5% in general population. The risk of CRC mortality of those with adenomas removed was the same as those without adenomas at 10years.


Karen pages not put on Private page 2011 Sections, background sections based on general literature summary (review 2011 content and update where required):



Current colonoscopy findings:
SIZE of largest adenoma
1-5mm
6-9mm
<10mm
Total number of adenomas
1-2
HGD and/or villosity
HGD and/or villosity
HGD and/or villosity
No
Yes
No
Yes
No
Yes
10Ya,b
5Y
10Ya,b
5Y
3Y
 3Y
3-4
HGD and/or villosity
HGD and/or villosity
HGD and/or villosity
No
Yes
No
Yes
No
Yes
5Y
3Y
5Yc
3Y
3Y
1Y
≥5
HGD and/or villosity
HGD and/or villosity
HGD and/or villosity
No
Yes
No
Yes
No
Yes
TBA
TBA
TBA
TBA
TBA
TBA





Current colonoscopy findings:
SIZE of largest adenoma
1-5mm
6-9mm
<10mm
Total number of adenomas
1-2
HGD and/or villosity
HGD and/or villosity
HGD and/or villosity
No
Yes
No
Yes
No
Yes
10Ya,b
5Y
10Ya,b
5Y
3Y
 3Y
3-4
HGD and/or villosity
HGD and/or villosity
HGD and/or villosity
No
Yes
No
Yes
No
Yes
5Y
3Y
5Yc
3Y
3Y
1Y
≥5
HGD and/or villosity
HGD and/or villosity
HGD and/or villosity
No
Yes
No
Yes
No
Yes
TBA
TBA
TBA
TBA
TBA
TBA






PDF download: National Cervical Screening Program guidelines


Draft content for public consultation

The public consutlation period on the draft follow up and diagnosis and staging questions has now closed (3-30 July). The Working Party is now considering feedback received. The three questions on screening and early detection (appearing outside of this orange box) have already undergone a public consultation process and are published.

Chemotherapy

Introduction

Ideally, routine follow-up in melanoma patients should be conducted in a cost-effective manner that has been scientifically proven to be beneficial. Unfortunately, however, guidelines for follow-up are typically based only on opinions of experts around the world as there have been no valid randomised trials comparing different follow-up schedules and patient survival. The best guidelines available to date come from 2013 German Guidelines Malignant melanoma S3-guideline "diagnosis, therapy and follow-up of melanoma"[1] and systematic reviews of all the available reports on follow-up schedules[2][3].

The main purpose of follow-up is to detect recurrences early so that early treatment can be undertaken. This assumes that earlier treatment is likely to result in improvements in regional disease control, quality of life and survival. Therefore, follow-up should be mainly prognosis-oriented but should also include the detection of new invasive melanomas. The reported incidence of new primaries ranges from 2–8%.[2][3][4] A second invasive melanoma is most commonly thinner than the initial primary melanoma and has a more favourable prognosis which does not adversely affect survival.[1] The rate of occurrence of a subsequent in-situ melanoma is about four times higher than the risk of a subsequent invasive melanoma[5], but most series do not recommend follow-up for in-situ melanomas.[6]


The first section of draft content for these guidelines is open for initial public comment from the period of 19 August 2016 to 3 October 2016. Template:COSA status

Draft content for public consultation

The following draft content is available for public consultation from 3 July 2017 to 30 July 2017. Please see the instructions on how to provide feedback.

Please note the links in this box are the only questions open for review and public consultation. The three questions on screening and early detection (appearing outside of this orange box) have already undergone a public consultation process and are published.

Diagnosis and staging:

Follow up:






Risk category by family history

Number of 1st degree relatives with CRC before age 55
0 1 2
Number of 1st degree relatives with CRC at 55 or older
0 1 2 3 0 1 2 0 1
Number of 2nd degree relatives with CRC before age 55
0
Number of 2nd degree relatives with CRC at 55 or older
0 1 1 2 3 2 2 3 2 3
1 1 1 2 3 2 3 3 3 3
2 1 2 3 3 3 3 3 3 3
3 2 2 3 3 3 3 3 3 3
4 2 3 3 3 3 3 3 3 3
1 0 1 2 3 3 2 3 3 3 3
1 2 3 3 3 3 3 3 3 3
2 3 3 3 3 3 3 3 3 3
2 0 2 3 3 3 3 3 3 3 3
1 3 3 3 3 3 3 3 3 3


Clinical question:Which populations require special consideration to minimise risk when providing cancer therapy? Need to delete update group Guidelines:COSA:Cancer chemotherapy medication safety guidelines/Special considerations for paediatrics Need to delete update group


Clinical_question:What special considerations are required to minimise risk when providing cancer therapy to older adults?

Clinical_question:What special considerations are required to minimise risk when providing cancer therapy to paediatric patients?


Please also see the following files:

To request a PDF version of the draft guideline or the short-form draft guideline, please contact the Project Manager, Clinical Guidelines Network at guidelines(at)cancer.org.au or phone (02) 8063 4116.


Info in box


Public consultation

These draft guidelines are open for public consultation from 10 March 2017 to 8 April 2017. Please click the button below for information about public consultation, including how to make a comment.

Public consultation




On this page will have to add in: |sidebar=MediaWiki:Colorectal_cancer/sidebar into markup later when not private Also will have to take /Private off each page in guidelines when the landing page moved back to public.

Please also see the draft dissemination report and administration report.

To request a PDF version of the guideline documents, please contact the Project Manager, Clinical Guidelines Network at guidelines(at)cancer.org.au or phone us on (02) 8063 4116.

download icon PDF download: National Cervical Screening Program guidelines

download icon PDF download: National Cervical Screening Program short-form guidelines (recommendations only)

you could use |suppress header links=true in Clinical guideline template on page where you want 'Cite this page' not to appear


About this guideline

Dec 2016: To be drafted

Summary

Dec 2016: To be drafted






Draft content for Working Party review (Feb 2017)

Follow-up after curative resection for colorectal cancer

Adjuvant therapy for colon cancer

Management of resectable locally recurrent disease and metastatic disease

Management non-resectable locally recurrence disease and metastatic disease


Appendices



View Systematic review report PPR1 Systematic review report PPR1 View NHMRC Evidence statement form PPR1 NHMRC Evidence statement form PPR1


http://wiki.cancer.org.au/australia/Template:PublicConsultation


Draft content for public consultation

Some content

and you can add custom style to it, to set size, color...




Public consultation


Cervical e-learning module: http://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Screening/E-learning

Test wiki: http://wiki.cancer.org.au/australia_test

testpageonly

  1. 1.0 1.1 Pflugfelder A, Kochs C, Blum A, Capellaro M, Czeschik C, Dettenborn T, et al. Malignant melanoma S3-guideline "diagnosis, therapy and follow-up of melanoma". J Dtsch Dermatol Ges 2013 Aug;11 Suppl 6:1-116, 1-126. doi: 10.1111/ddg.12113_suppl.
  2. 2.0 2.1 Francken AB, Bastiaannet E, Hoekstra HJ. Follow-up in patients with localised primary cutaneous melanoma. Lancet Oncol 2005 Aug;6(8):608-21 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16054572.
  3. 3.0 3.1 Nieweg OE, Kroon BB. The conundrum of follow-up: should it be abandoned? Surg Oncol Clin N Am 2006 Apr;15(2):319-30 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16632217.
  4. Ferrone CR, Ben Porat L, Panageas KS, Berwick M, Halpern AC, Patel A, et al. Clinicopathological features of and risk factors for multiple primary melanomas. JAMA 2005 Oct 5;294(13):1647-54 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16204664.
  5. Dicker TJ, Kavanagh GM, Herd RM, Ahmad T, McLaren KM, Chetty U, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol 1999 Feb;140(2):249-54 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10233217.
  6. Roberts DL, Anstey AV, Barlow RJ, Cox NH, et al. U.K. guidelines for the management of cutaneous melanoma. Br J Dermatol 2002 Jan 1;146(1):7-17 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11841361.